Emergency Service Operations Research Articles

Evaluation and Enhancement of Triaging Services Through Quality Improvement Tools at Primary Health Care Level: A Clinical Audit Study.

The effective and efficient operation of emergency services at healthcare depends on triage decisions. Successfully implementing a triage system improves patient care, communication, and self-assurance. A baseline audit was conducted by reviewing a sample of 554 triage health records in September 2021. Many gaps were identified in the practice, and action plans were developed for improving it. Following the implementation of the action plan, a re-audit was conducted in September 2022 with a sample of 470 medical records. Evidence suggested that nurses had made progress in correctly allocating the medical emergency triage category from 63% at baseline to 90% at the reaudit. The over-triage decreased in accordance with this adjustment, from 37% to 10%. Compliance with the suggested time target of 5 minutes for physicians to attend medical emergencies has shown a small improvement from 48% at baseline to 55% in the re-audit. Similar improvements were demonstrated in the other triage categories. A problem may have several causes, and since it is impossible to address every one of them, prioritizing the causes is usually the best course of action. Inadequate triage classification by nurses was one of the key reasons for the delay in physician appointment times in triage clinics. Triage nurses' abilities should be enhanced to make this triage judgment. The audit team suggested that nurses should be given problem-based training, which will enhance the entire triage procedure.

Research Design of Mobile Based Decision Support for Early Flood Warning System

Flooding has become one of the most rapidly growing types of natural disaster that has spread around the globe. It is is one of the major natural hazards in many countries and mostly affected in the low-lying or flood prone areas. In order to minimize loss of life and economic losses, a detailed and comprehensive decision making tool is necessary for both flood control planning and emergency service operations. In this paper, we demonstrate our research design for mobile based decision support of Flood Early Warning System (FEWS). We outlined four research objectives. Firstly, critical criteria for flood risk assessment will be identified and the second step will involve develop measurement model for relative flood risk using Geographic Information System (GIS), Multi Attribute Decision Making (MADM) and data mining technique. In the third objectives, the holistic architectural design is develop by incorporating the communication technology and other related ICT requirements for the mobile decision support. The fourth objective is to validate the mathematical model and architectural design. Case study approach is chosen in order to understand the flood event and validate the decision support model. Following well-defined procedures, flood maps were drawn based on the data collected from expert responses to a questionnaire, the field survey, satellite images, and documents from flood management agencies. It is anticipates that by integrating of mathematical model, GIS and mobile application in flood risk assessment could provide useful detailed information for flood risk management, evacuation, communication. The decision support design from this study is perhaps to improve the warning system and contribute to reduction of casualties.

Smart Shirts for Monitoring Physiological Parameters: Scoping Review.

BackgroundThe recent trends of technological innovation and widescale digitization as potential solutions to challenges in health care, sports, and emergency service operations have led to the conception of smart textile technology. In health care, these smart textile systems present the potential to aid preventative medicine and early diagnosis through continuous, noninvasive tracking of physical and mental health while promoting proactive involvement of patients in their medical management. In areas such as sports and emergency response, the potential to provide comprehensive and simultaneous physiological insights across multiple body systems is promising. However, it is currently unclear what type of evidence exists surrounding the use of smart textiles for the monitoring of physiological outcome measures across different settings.ObjectiveThis scoping review aimed to systematically survey the existing body of scientific literature surrounding smart textiles in their most prevalent form, the smart shirt, for monitoring physiological outcome measures.MethodsA total of 5 electronic bibliographic databases were systematically searched (Ovid Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Scopus, Cumulative Index to Nursing and Allied Health Literature, and SPORTDiscus). Publications from the inception of the database to June 24, 2019 were reviewed. Nonindexed literature relevant to this review was also systematically searched. The results were then collated, summarized, and reported.ResultsFollowing the removal of duplicates, 7871 citations were identified. On the basis of title and abstract screening, 7632 citations were excluded, whereas 239 were retrieved and assessed for eligibility. Of these, 101 citations were included in the final analysis. Included studies were categorized into four themes: (1) prototype design, (2) validation, (3) observational, and (4) reviews. Among the 101 analyzed studies, prototype design was the most prevalent theme (50/101, 49.5%), followed by validation (29/101, 28.7%), observational studies (21/101, 20.8%), and reviews (1/101, 0.1%). Presented prototype designs ranged from those capable of monitoring one physiological metric to those capable of monitoring several simultaneously. In 29 validation studies, 16 distinct smart shirts were validated against reference technology under various conditions and work rates, including rest, submaximal exercise, and maximal exercise. The identified observational studies used smart shirts in clinical, healthy, and occupational populations for aims such as early diagnosis and stress detection. One scoping review was identified, investigating the use of smart shirts for electrocardiograph signal monitoring in cardiac patients.ConclusionsAlthough smart shirts have been found to be valid and reliable in the monitoring of specific physiological metrics, results were variable for others, demonstrating the need for further systematic validation. Analysis of the results has also demonstrated gaps in knowledge, such as a considerable lag of validation and observational studies in comparison with prototype design and limited investigation using smart shirts in pediatric, elite sports, and emergency service populations.

Social Media as a Source of Information and Misinformation on the Example of the Notre Dame Fire

Aim: The aim of this article is to analyse the activity of individual users, institutions and organisations in social media in the context of the fire in the Notre Dame Cathedral. The main threats of using this type of tools in crisis communication are presented, with particular emphasis on the propagation of information and disinformation. Introduction: The development of social media (platforms) in the global Internet means that they have become a tool commonly used by various types of private organisations, public administration and services. Using this medium gives great opportunities in the process of providing current information, efficient communication with the local community, building positive relations and creating a positive image of the organisation. Social media are also used by the government administration and emergency services of many countries during each of the four phases of crisis management (mitigation, preparedness, response, recovery). Information and communication technologies together with social media play an important role in contemporary people’s lives. They constitute an important part of everyday reality and are intrinsically related to it. The fire of the Notre Dame Cathedral in 2019 was widely commented on social media. The existing traditional methods of communication, such as press, television or radio, have significant limitations consisting in the inability to interact with the media users. Only the person who created the information could be the broadcaster. The internet, and social media in particular, has changed dramatically this state of affairs, giving recipients the opportunity to interact with people/institutions generating content. Methodology: The method applied in the article is that of literature review in the area of Web 1.0, Web 2.0, Web 3.0 development as well as the course of the fire of the Notre Dame Cathedral. Statistical analysis was performed using Google Trends. The paper indicates the main sources of opportunities and threats to users' activity in social media, with particular emphasis on the aspects related to the efficient operation of emergency services. Conclusions: The role of social media in crisis situations has not yet been established. It is evolving and it can be expected that with time it will be used to an increasing extent also in cases such as fires and other threats to cultural goods. The authors recommend further research on the behaviour of users of social networking sites, groups and the entire portal.

Heat-related morbidity: real-time surveillance via rescue service operations data from the interdisciplinary care capacity proof system (IVENA)

In addition to mortality data, hospital admission, emergency department visits, and emergency service calls data are used for the surveillance of heat-related morbidity. We report on heat-associated morbidity in Frankfurt am Main from 2014-2018 using the web-based care capacity proof system (IVENA) of the rescue service operations. In the web-based IVENA system, all patients with prehospital emergency care are recorded in real time. The rescue service operations were evaluated in the summer months (June-August) from 2014-2018 in Frankfurt am Main as awhole and separately according to various heat-related diagnoses. The current temperature data of the Frankfurt East measuring station were obtained online as hourly values from the website of the Hessian Institute for Nature Conservation, Environment and Geology ( www.hlnug.de ). Temperature maxima ≥32 ℃ for at least 5 days were defined as a "heatwave." From 2014-2018, three heatwaves occurred according to the definition above: in 2015, 2016, and 2018, with an extremely long heat period in 2018 (17days). During the heatwave in 2015, the highest excess morbidity was noted: +17% total ambulance service operations and +198% emergency service operations due to heat-related disease disorders. The evaluation of the long heat period in 2018 showed that with increasing duration of the heat period, the emergency rescue service operations due to total heat-associated morbidity remained high with increasing emergency service operations due to exsiccosis and unclear fever. The data obtained by the IVENA system enable acurrent and complete assessment of severe acute diseases in the city or in the respective rescue service area in real time. Health effects of heat events can thus be investigated in real time and the system can be used as an early warning system for prevention.

State evaluation of road transport safety of dangerous goods in Poland

The article presents problems and threats related to the transport of dangerous goods. The statistical data of breakdowns and road accidents involving dangerous goods were concluded. The article describes the results of own research related to the transport of dangerous goods. Finally, the structure of the road transport safety system for dangerous goods was proposed, which will reduce the risk of dangerous incidents and improve the operation of emergency services.

An analysis of p-median location problem: Effects of backup service level and demand assignment policy

Any solution to facility location problems will consider determining the best suitable locations with respect to certain criteria. Among different types of location problems, involving emergency service system (ESSs) are one of the most widely studied in the literature, and solutions to these problems will mostly aim to minimize the mean response time to demands. In practice, however, a demand may not be served from its nearest facility if that facility is engaged in serving other demands. This makes it a requirement to assign backup services so as to improve response time and service quality. The level of backup service is a key, strategic-level planning factor, and must be taken into consideration carefully. Moreover, in emergency service operations conducted in congested demand regions, demand assignment policy is another important factor that affects the system performance. Models failing to adopt sufficient levels of backup service and realistic demand assignment policies may significantly deteriorate the system performance.Considering the classic p-median problem (pMP) location model, this paper investigates the effects of backup service level, demand assignment policy, demand density, and number of facilities and their locations on the solution performance in terms of multiple metrics. For this purpose, we adopt a combined optimization and simulation approach. We will first modify the classic pMP to account for distances to backup services. Next, we employ a discrete event simulation to evaluate the performance of location schemes obtained from the deterministic mathematical model. Our results provide insights for decision-makers while planning ESS operations.

EMERGENCY RESCUE MANAGEMENT SUPPORTED BY UAV REMOTE SENSING DATA

Abstract. In the proposed SAFEDAM system, aerial and satellite-based information is used for the monitoring of river bodies, flood monitoring during the event, and for post-disaster damage assessment. UAV constitute a valuable source of information about the current situation in the field during the operation of emergency services. Time is crucial, and the basic assumption to use UAV remote sensing data is to make them available immediately after landing. Therefore, the approach of automatic orthomosaics created based on the exterior orientation of the transmitted images using direct georeference was selected instead of sophisticated automatic on-the-fly image-matching and georeferencing. The article conveys the justification for selecting this option in order to process orthomosaics with lower localisation accuracy in a short time. The developed algorithm takes into account the elements of exterior and interior orientation of the camera as well as the digital terrain model. The evaluation of the orthomosaic was conducted based on theorthophoto created in post-processing. Thanks to the approach used, images from the platform are available in the near real time on the screen of the interventional mode of the SAFEDAM system and are an extremely valuable and informative source of data. The system also integrates tools, which support the management of the action and prepares site documentation.

Flood damage assessment of an urban area in Taiwan

In Taiwan, flooding is one of the major natural hazards causing death and millions of dollars of economic losses every year. In order to minimize damage, a detailed and comprehensive flood damage assessment is necessary for both flood control planning and emergency service operations. As such, the objectives of this study were to assess possible flood damages and provide a comprehensive flood risk index for Taichung City in Taiwan. An analytic hierarchy process questionnaire, which included the factors of different land-use types, was designed and answered by 33 experts from governments, industry, and academia in Taiwan. Questionnaire responses were analyzed, and numerical values were allocated for each land-use type. A flood risk index was then produced by combining the potential of inundation and the flood damage scores. Higher flood risk was found along major roads and the main channel of the Fazih River. The methodology used in this study can be applied to most urbanized areas in Taiwan and elsewhere in the world when the required data sets are available.

국내 구급차량의 운행 중 사고 분석에 관한 조사 연구

The purpose of this study is to investigate the circumstances surrounding collisions involving ambulances with an aim to improving the safe operation of emergency services. Collisions are relatively common within paramedic emergency services. We analyzed the time, injury site, and any other specific factors of 908 collisions occurring within four cities. Within our study 29.6% of paramedics have been involved in accidents while responding to an emergency call, with the main cause of the accident being signal violation (35.7%), and is the other party's negligence (22.2%). 92.1% of these accidents occurred while the emergency lights were being operated. XX% of accidents took place in the afternoon, while xx% took place within the hours of xx:xx and xx:xx, during which time there is generally lower levels of traffic, which can cause severe brain and neck damage of 14.4% but the other part is 62.1%. (Ed note; this is not clear at all. 14.4% of collisions resulted in severe head and neck injuries, while 23.5% of collisions resulted in no injury. According to the respondents, defensive driving (xx%), observance of traffic laws (xx%), safe driving habits (xx%)to paramedics were the most critical factors in evading collision. Signal passes were identified as the most common cause of collision (70.1%). Although the majority of collisions occurred while the emergency lights were operational, the damage can cause severe damage at the time of accident occurred. Language: ko

Book Review: The Definitive Guide to Emergency Department Operational Improvement and Quality Matters: Solutions for a Safe and Efficient Emergency Department

The Definitive Guide to Emergency Department Operational Improvement and Quality Matters: Solutions for a Safe and Efficient Emergency DepartmentReviewed by Frank Zilm, FAIA, FACHAQuality Matters: Solutions for a Safe and Efficient Emergency Department. (2009).Shari J. Welch. Oak Park, IL: Joint Commission Resources (Softcover).The Definitive Guide to Emergency Department Operational Improvement. (2011).Jody Crane and Chuck Noon. New York, NY: CRC Press.A fundamental question in evidence-based design is where design begins. Is it in the strategic vision, the programming, or the translation into an architectural design concept?If we follow the somewhat worn edict that form follows function, it is logical that we should understand the operations of an emergency service before engaging a design solution. As with other areas of healthcare design, innovation and creativity are spurred by an understanding of the patient, staff, and organizational needs of a service.Two recent books on emergency service operations provide an interesting and informative contrast in content; one offers a wide breadth of exposure to emergency department (ED) issues and operations, and the other provides a deep-dive look into the world of Lean applications in the ED service.Quality Matters: Solutions for a Safe and Efficient Emergency Department uses a broad definition of quality to expose readers to a breadth of issues related to emergency care and management. The stated purpose of the book is to provide practical solutions to the ED environment by providing realworld examples of common problems that occur in most EDs (Welch, 2009, p. 2).Dr. Welch's initial focus is on establishing a quality improvement program. Her definition of quality in medicine includes service, clinical, and financial quality. The author identifies the five key components of a quality improvement program as (1) census data; (2) metrics; (3) operational data; (4) provider-specific data; and (5) focused audits/improvements. Topics addressed in service quality include benchmarking, standardization of processes, and statistical analysis of key ED data. Examples, drawing heavily on the LDS hospital system in Utah where she practices, provide useful illustrations of the concepts discussed.The chapter on demand capacity management presents some innovative ideas for smoothing the traditional ebbs and flows of patient arrivals. Could the ED use incentives to urge patients to come back to the ED for nonurgent complaints during lowcensus periods? Could the registration area for the hospital be used as a rapid medical screening area at night? Could the orthopedic rooms be used as a satellite intensive care unit (ICU, staffed by ICU staff) when the ICU is overcrowded?The chapter on statistical process control provides a basic introduction to the application of statistical techniques for process control. Queuing theory and other techniques are not covered in great detail.The chapter on management provides an interesting insight into a common stumbling block in planning new facilities. Teamwork is not a natural phenomenon for a physician. In fact, medical training and physician culture tend to promote rugged individualism. Anyone involved in improvement efforts can attest to the challenges inherent in leading physicians through change. Understanding the culture in which physicians are trained and practice helps in understanding the difficulties in changing physician behavior (Welch, 2009, p. 109). Amen. Her suggested strategies for addressing this problem include the use of data to make a case for change, appealing to competitiveness through feedback, getting physicians involved on the ground floor, aligning incentives with patient care, and using pilot studies. These are all potentially good techniques when combined with the most important identified component of her proposed change team: a respected physician who will campaign as a champion of the new approaches. …

Integrated application of the analytic hierarchy process and the geographic information system for flood risk assessment and flood plain management in Taiwan

Flooding is one of the major natural hazards in Taiwan, and most of the low-lying areas in Taiwan are flood-prone areas. In order to minimize loss of life and economic losses, a detailed and comprehensive decision-making tool is necessary for both flood control planning and emergency service operations. The objectives of this research were (i) to develop a hierarchical structure through the analytic hierarchy process (AHP) to provide preferred options for flood risk analysis, (ii) to map the relative flood risk using the geographic information system (GIS), and (iii) to integrate these two methodologies and apply them to one urban and one semi-rural area in central Taiwan. Fushin Township and the floodplain of Fazih River (1 km on either side of the channel) in Taichung City were selected for this study. In this paper, the flood risk is defined as the relative flood risk due to broken dikes or the failure of stormwater drainage systems. Seven factors were considered in relation to the failure of stormwater drainage, and five to that of broken dikes. Following well-defined procedures, flood maps were drawn based on the data collected from expert responses to a questionnaire, the field survey, satellite images, and documents from flood management agencies. The relative values of flood risk are presented using a 200-m grid for the two study areas. It is concluded that integration of AHP and GIS in flood risk assessment can provide useful detailed information for flood risk management, and the method can be easily applied to most areas in Taiwan where required data sets are readily available.

New Directions in Emergency Service Operations and Planning

Emergency services continue to evolve new operational and facility concepts in response to increasing demand for care and pressures for efficient, and safe, patient management. This article describes new models for "intake" of patients and for responding to peak demand that are radically changing the traditional emergency service. Application of Six Sigma and "Lean" analysis techniques are demonstrating dramatic improvements in throughput times and in the utilization of treatment spaces. This article provides an overview of the application of Lean concepts to emergency services. Case studies of Mary Washington Hospital and Banner Health Corporation illustrate the result of application of these tools. Implication for the required patient care areas and design concepts are also discussed.

Intelligence-Led Mitigation

This paper explores methods for capitalizing on existing law enforcement intelligence capabilities to provide intelligence support to decision makers for a full spectrum of public safety and emergency service operations. Intelligence-led mitigation is a management philosophy and business process to proactively guide strategic, operational, and tactical decisions for mitigating the effects of intentional, accidental, and natural incidents. There is currently a gap in the intelligence products needed by public safety and emergency service organizations to support their resource decisions, and the quantity and quality of intelligence products they are receiving. This breach between producer and consumer exists across the country and at all levels of government. The intelligence-led mitigation model was designed to demonstrate how the existing principles and processes of intelligence-led policing can be applied to a broader set of incidents, incident phases, and stakeholders in order to effectively and efficiently fill this critical intelligence gap.

Acute pain and availability of analgesia in the prehospital emergency setting in Italy: A problem to be solved

Objectives: The treatment of acute pain in the prehospital emergency setting remains a significant problem. We evaluated the incidence, site, and possible cause of acute pain in the prehospital period and also the current state of prehospital pain management by evaluating analgesic availability in emergency vehicles in Italy. Methods: First aid volunteers documented the presence, intensity, and site of acute pain by questionnaire for over 3 months. Emergency service operations completed a questionnaire on analgesic availability in ambulances and helicopters. Results: Pain symptoms were present in two-thirds of the patients (n = 383) and ranked as moderate to unbearable in 41.75%. Results of the analgesic availability survey indicate that 10.6% of the ambulance services carry no pain killers (including non-steroidal anti-inflammatory drugs [NSAIDs]and/or paracetamol) and 11.5% are without an opioid. The emergency helicopter survey showed a significant difference in analgesic availability compared with ambulances, with 97.6% having at least one opioid agent available (weak or strong). A wide geographical variation in the availability of analgesic agents in ambulance and helicopter services was seen. Conclusions: There is a high prevalence of pain among patients receiving prehospital emergency treatment in Italy and treatment for acute pain during emergency treatment of trauma patients is inadequate. All emergency vehicles, without distinction, should carry opioids and other analgesic drugs (NSAIDs and paracetamol) and there should be no geographic differences in the availability of pain medications. © Journal compilation © 2009 World Institute of Pain.

Acute Pain and Availability of Analgesia in the Prehospital Emergency Setting in Italy: A Problem to be Solved

The treatment of acute pain in the prehospital emergency setting remains a significant problem. We evaluated the incidence, site, and possible cause of acute pain in the prehospital period and also the current state of prehospital pain management by evaluating analgesic availability in emergency vehicles in Italy. First aid volunteers documented the presence, intensity, and site of acute pain by questionnaire for over 3 months. Emergency service operations completed a questionnaire on analgesic availability in ambulances and helicopters. Pain symptoms were present in two-thirds of the patients (n = 383) and ranked as moderate to unbearable in 41.75%. Results of the analgesic availability survey indicate that 10.6% of the ambulance services carry no pain killers (including non-steroidal anti-inflammatory drugs [NSAIDs] and/or paracetamol) and 11.5% are without an opioid. The emergency helicopter survey showed a significant difference in analgesic availability compared with ambulances, with 97.6% having at least one opioid agent available (weak or strong). A wide geographical variation in the availability of analgesic agents in ambulance and helicopter services was seen. There is a high prevalence of pain among patients receiving prehospital emergency treatment in Italy and treatment for acute pain during emergency treatment of trauma patients is inadequate. All emergency vehicles, without distinction, should carry opioids and other analgesic drugs (NSAIDs and paracetamol) and there should be no geographic differences in the availability of pain medications.

On time distortion under stress

Under conditions of extreme and life-threatening stress, people often report distortions of time. These distortional experiences are critical since, axiomatically, they occur in circumstances where small variations in behavior can mean the difference between survival and extinction. The present work examines the spectrum of evidence concerning such phenomena including observations from real-world events such as combat, ejection from high-performance aircraft, driving in dangerous environments and from less stressful, yet informative laboratory procedures. A contextual theory is promulgated which postulates that in addition to draining attentional resources, stress prevents the efficient production of such resources. The stress-depleted resources which remain are directed to task-relevant activities and consequently attention to time-based cues is minimized resulting in distortion effects for both time-in-passing and for time recollection in memory. A number of practical observations are advanced concerning the performance of professionals who are likely to meet such conditions in their occupations including those in aerospace, military, fire-fighting, law enforcement, and medical emergency service operations. In conclusion, we present a number of future research strategies that may be enacted in order to evaluate this ephemeral, real-world phenomenon.

Earthquake engineering in Australia

Earthquake Engineering in Australia, as elsewhere, has been formatted in the aftermath of damaging earthquakes. The first Australian Code AS2121-1979 was written and published after the 1968 Meckering WA earthquake. The second AS1170.4 1993 was published after the 1989 Newcastle NSW earthquake. Good quality Building Codes are a necessary basis for sound earthquake resistant designs. Both implementation and enforcement of the codes and sound robust construction in the field are essential for the protection of life and infrastructure. Also essential is the preservation and upgrading of the earthquake database. A study to assist the safer operation of emergency services immediately following damaging earthquakes is proposed.